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CITY OF IOWA CITY
410 East Washington Street
I o wa Li4y,. -tavvz-5240- 1$ 2 6
(F.I 9) 356-5040 �h 4/i
(319) 356-5497 FAX
1. Name
2. Mailing
Authorization Number 113--19
(Office Use Only)
APPLICATION FOR TAXI DRIVER
(folic mentreviewmust-be_made
een 8 a.m. to 3 p.m., Monday - F!! .
3. Telephone: Home (-Oc( (- SLS -:213 ) Other:
4. Prior experience in transportation of passengers: ✓"ti _Q-
5. Have you ever been convicted of any misdemeanors and/or felonies in this State or elsewhere?
Type of offense
Where
When
6. Have you been convicted of operating a motor vehicle while under the influence of alcohol or drugs in the last five
years? ✓1-0
Type of Offense
Where
7. Have you been convicted of any traffic offenses in the last five years? -Y -G S
Type of offense
Where
When
When
8. Has your driver's license or chauffeur's license been suspended or revoked in the last five years?y-o S
9. Have you ever applied to bean Iowa City taxi driver using a different name? If yes, please provide the name(s)
DEPARTMENT OF CRIMINAL INVESTIGATION (DCI) REPORT AND STATE CERTIFIED
DRIVING RECORD MUST ACCOMPANY THIS APPLICATION FOR POLICE CHIEF REVIEW
You must apply for an individual Department of Criminal Investigation Report (form available upon request).
(OVER FOR REQUIRED SIGNATURE AND NOTARY)
G�&Ivv d9 03/2013
I hereb certify that I have issued to me by the Iowa Department of Transportation a valid Chauffeur's license number
% C 13 2� I understand that if I falsely answer any questions in this application, that this
application may be denied. I understand that if I falsely answer any of the questions in this application, that this application will
be denied. I agree that in making this application, I consent to allow agents or employees of the City of Iowa City, Iowa, in
their discretion, to examine any and all records and documents relating to this application, and I further agree that, if a license
is granted, to comply at all times ith all of th provisions of Title 5, Chapter 2, of the City Code. (Needs to be signed in front
of a Notary Public) /�%'/,�),
Signature of
Date �
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STATE OF IOWA )
COUNTY OF JOHNSON )
ubscribeandswom to before me by haOl W 1 Kie C 4 On this �"`— day of
Yl 1 .lr�—C] 1 _
c[LUE K. TUTTLE .� L.
-' ision Number 221919
ommissJch Eapj es Notary Public in and for the State of Iowa
1 have reviewed this application, DCI report, and the State certified driving record of this applicant and have deter-
mined that there is no information which would indicate that the issuance would be detrimental to the safety, health
or welfare of residents of the City of Iowa City (Title 5, Chapter 2, City Code).
Signa re of Pof a hief or designee
Date
YOU ARE NOT VALID TO DRIVE A TAXI IN IOWA CITY UNTIL AUTHORIZATION IS RECEIVED FROM THE CITY
CLERK'S OFFICE. Authorized taxi driver names are placed on the city website at icgov.org.
S
ignatu City Clerk or designe
-/3
Date
Taxi cab businesses are required to provide Driver Identification cards. Cards must be 8 %" (width) and 51/2'
(height) and prominently displayed to all passengers.
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Office Use Only
Approved application
DCI report
State certified driving record
Website update
den divbeeeeawm10a 03/2013
Apr. 4. 2013 4:18PM Div of Criminal Investigation No.8953 P. 1/3
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TDVM arim;naMinforyRecord attached, bCZ#
�7G'ialait%Is�
Para;vA1 Tiraa-Mar 9a —Ml— A-11PM—MA UAr,
11
Apr. 4. 2013 4:18PM Div of Criminal Investigation
IOWA CRIMINAL HISTORY DCI 00472643
FELONY CONVICTION PAGE 1 OF 2
DATE PRINTED -
2013/04/04
DCI:00472643
NAME: WINTERS,CHAD DAVID
DOB SEK RAC HGT WGT EYE HAIR SxN POB
19751021 M W 602 190 BLU BRO FAR IA
ADDITIONAL IDENTIFIERS
SC L RLB
TAT R SHLD
CCH RECORD ***
01 ARRESTED 19931217
AGENCY: IA0790100 GRINNELL PD
CHARGE NO- 01 IA STATUTE IA321-561
DRIVE WHILE BARRED
TRK#: 000313301
COURT DISPOSITION
AGENCY: IA079015J POWESHIEK CO DIST COURT
COUNT NO- 01 IA STATUTE IA321-561
DRIVE WHILE BARRED
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 000313301
SENTENCE
PLEAD GUILTY
FINE $500
02 ARRESTED 19950514
AGENCY: IA0790000 POWESHIEK CO SO
CHARGE NO- 01 IA STATUTE IA908-1
PROBATION VIOLATION
TRK#: 016301101
COURT DISPOSITION
AGENCY: IA079015J POWESHIEK CO DIST COURT
COUNT NO- 01 IA STATUTE IA906-1
PROBATION VIOLATION
CHARGE CLASS: STATUS UNKNOWN
TRK#: 018301101
SENTENCE
JAIL 60D
COURT COSTS
03 ARRESTED 19970827
AGENCY: IA0790100 GRINNELL PD
CHARGE NO- 04 IA STATUTE IA720-4
TAMPERING W/WITNESS
TRK#: 017593104
COURT DISPOSITION
AGENCY: IA079015J POWESHIEK CO DIST COURT
COUNT NO- 04 IA STATUTE IA720-4
TAMPERING W/WITNESS
DISP EFF DAT
19940126
19940126
DISP EFF DAT
19951215
19951215
No. 8953 P. 2/3
u
Apr. 4. 2013 4:18PM Div of Criminal Investigation
DCI 00472643
PAGE 2 OF 2
CHARGE CLASS: MISDEMEANOR CONVICTION
TRK#: 017593104
SENTENCE DXSP EFF DAT
PLEAD GUILTY 19980216
FINE $500 19980216
04 ARRESTED 19970829
AGENCY: IA0500000
JASPER CO SO
CHARGE NO- 01
IA STATUTE
IA709-4
SEXUAL ABUSE 3RD DEGREE
TRK#; 018947901
COURT DISPOSITION
AGENCY: IA050015J
JASPER CO DIST COURT
COUNT NO- 01
IA STATUTE
IA709-4(2)(C)(4)
SEXUAL ABUSE 3RD DEGREE
CHARGE CLASS: FELONY
CONVICTION
TRK#: 018947901
SENTENCE
DISP EFF DAT
FINE
$500
19980223'
COURT COSTS
19980223
SUSPENDED PRISON
10Y
19980223
PROBATION
3Y
19960223
AN ARREST WITHOUT DISPOSITION IS NOT AN INDICATION OF GUILT. THIS RECORD
MAINTAINED BY THE IOWA DIVISION OF CRIMINAL INVESTIGATION, BUREAU OF
IDENTIFICATION IS A PUBLIC RECORD BUT CAN ONLY B2 RELEASED TO NON -LAW
ENFORCEMENT AGENCIES BY THE DCI.
IN THE ABSENCE OF FINGERPRINTS FOR POSITIVE IDENTIFICATION THIS RECORD I5
BASED ON INFORMATION FURNISHED. WE CANNOT CONFIRM OR DENY THAT THE RECORD
COVERS THE SUBJECT OF YOUR INQUIRY.
DIVISION OF CRIMINAL INVESTIGATION
No, 8953 P. 3/3
AC
Iowa. Department of Transportation
Office of Driver Services (To[ Free) 800.532.1121
Poi Sox 3304, Des Mines, LA 503D&0204 515-244-9124
FAX= 51' 739.12:37
Inquiry Date:
Name:
Address:
City/State:
Mailing Address:
Mailing
City/State:
Convictions
Certified Abstract of Driving Record
3/29/2013
DL/ID #:
Winters, Chad David Class:
4274 WOODLAND
Audit #:
HILLS DR
10/21/2014
CDL Cert Status:
Issue Date:
BROOKLYN, IA
Expiration Date:
522119586
03/11/2008
04/07/2008
Endorsements:
4274 WOODLAND Restrictions:
HILLS DR
Date of Birth:
BROOKLYN, IA Sex:
522119586
174CC1324 (IA) Customer #:
C
ID Status:
6788724
OL Status:
03/20/2013
CDL Status:
10/21/2014
CDL Cert Status:
L CDL Med Status:
Commercial Restriction
Instruction Permit, Supplement:
Corrective Lenses
10/21/1975
M
History Information
1423633
None
VAL
VAL
Non -Excepted
Intrastate
None
CDL Instruction
Permit Expires
9/20/2013
Citation Date
Conviction Date
ACD
Explanation
County
JUR
03/11/2008
04/07/2008
S92
Seed
5o
IA
03/11/2008
04/07/2008
B64
No Insurance Card
50
IA
12/27/2008
01/30/2009
S92
Speed (10 mph &
77
IA
Child Support
under In 35-55 mph
zone
06/03/2009
07/08/2009
M14
Fail to Obey Traffic
79
IA
,Sign/Signal
06/07/2011
07/11/2011
F66
Unsafe condition of
FL
vehicle (no specified
com onent
Accidents - Accident involvement indicated does NOT mean the individual was at
fault or given a citation.
Accident Date
Case Number
JUR
12/31/2007
413606
IA
Sanctions
Type
Effective
End
ACD
Explanation
Occurrence
JUR
JUR
Suspended
03/21/2011
04/11/2011
D51
Nan -Payment of
IA
IA
Child Support
r..........
,.....-........
.............
.....
""' ' ..Y....... ..�
Child Support
Suspended
06/19/2012
07/16/2012
D51
Non -Payment of
IA
IA
Child Support
Name: Winters, Chad David DL/ID: 174CC1324
Pursuant to Iowa Code §321.10, I, Kim Snook, Director of Office of Driver Services, Iowa Department of Transportation, do
hereby certify that I am the custodian of the records held by the Office of Driver Services, that this is a true and accurate copy of
an official record currently in the custody of said Office, and that I have been authorized by the Director of the Iowa Department
of Transportation to so certify.
In witness whereof, I have caused my signature and the seal of the Department to be set upon this document, at Ankeny, Iowa
this date:
pn�54 3/29/2013
r�,...rr,r+y�/' Iwo
IOWAr'
Q. 0. T.� - -
Office of Driver Services
Iowa Department of Transporation
Name: Winters, Chad David DL/ID: 174CC1324